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50 Cards in this Set

  • Front
  • Back
The most important functions of the kidneys are to regulate the ______and composition of the ____
Volume, ECF (extra cellular fluid)
T or F: Kidneys require a "torrential" amount of blood flow to allow glomerular filtration.
True; Renal Blood Flow = 20% of resting CO
Glomerular Filtration Rate (GFR) is regulated mainly by...
balanced tone of afferent and efferent
arterioles.
Kidneys function by copious,
nonselective glomerular ________
and regulated tubular _________
of most of the filtrate.
filtration, reabsorption
Glomerular filtrate contains all small molecules in a similar concentration to plasma, but _____ are retained in the bloodstream.
Proteins
____ is the best measure of kidney function
GFR (glomerular filtration rate)
We use _______ as a marker for GFR
creatinine
As kidney function falls, serum creatinine ________
increases
Reabsorption of many solutes is
driven by...
basal and lateral Na-K-ATPase linked to many co-and counter-transporters. (Note that the Na-K_ATPase is the main character.)
ICF is rich in _______
ECF is rich in _______
(About 140 mEq/l each)
ICF is rich in potassium
ECF is rich in sodium
(About 140 mEq/l each)
Cell membranes are freely permeable to _____, which keeps the osmolality of the ICF and ECF equal.
Water
Plasma is rich in _______, while the interstitial fluid is opposite. _______ pressure from _______ keeps fluid in the circulation.
albumin, oncotic, albumin
ECF VOLUME is controlled by the balance of ____.
Na
ECF [Na] is controlled by _____ and ____.
Thirst, ADH
The entire renal cortex is _______ to plasma.
isotonic
Concentration/Dilution of urine is determined by the water-permeability of the _______ and ______ (via ADH).
Distal Convoluted Tubule (DCT), Collecting Duct (CD)
Potassium is mostly filtered in the _____ of the nephron, while most of the secretion takes place in the _____ of the nephron.
Proximal convoluted tubule, Distal convoluted tubule
Kidneys regulate plasma [K], [H+], [Ca], and a host of other concentrations, but will sacrifice all to the prime function of regulating ___ ______.
ECF Volume
General findings in GLOMERULAR disease
Proteinuria, Edema, HTN, hematuria (not all have to be present)
General findings in TUBULAR disease
NO (or little) proteinuria, NO edema, low/normal BP, NO hematuria
NEPHROTIC Syndrome
Proteinuria***, edema, hypoalbuminemia, hypercholesterolemia (not all have to be present)

Hint: nephROtic = pROtein
NEPHRITIC Syndrome
Hematuria***, HTN, Oliguria, Acute Renal Failure, Increased blood [K+]

Hint: Look for hematuria!
Acute Renal Failure: Onset and Prognosis
Minutes to Days; Reversible
Chronic Renal Failure: Onset and Prognosis
Months to Years; damage "arrestable" but not reversible. If progressing to end-stage renal disease, prepare for dialysis and/or transplant.
The junctional complexes between the epithelial cells become MORE _______ as you progress from the proximal convoluted tubule towards the collecting duct.
tight (less permiable)
Equation: Net filtration pressure
Puf = (Pgc -Pbs) - ONCOTICgc

Note: "Oncotic" is a pi symbol.
Equation: Glomerular Filtration Rate
GFR = (Kf)(Puf)

or

GFR = ((Ucreatinine)(V)) / (Pcreatinine)

Note: using the clearance equation of creatinine to estimate GFR will cause a slight overestimation because there is some secretion of creatinine into the filtrate.
Equation: Clearance
Cx = (Ux x V)/Px

Cx = Clearance of substance x from the plasma,
Ux = Concentration of substance x in the urine,
V = Flow rate of urine
Px = Concentration of substance x in the plasma.
Equation: Renal PLASMA Flow
RPF = (Upah x V) / Ppah

Upah = Urine concentration of PAH
Ppah = Plasma concentration of PAH
Note: We use PAH because it's filtered but NOT reabsorbed/secreted.
Equation: Renal Blood Flow
RBF = (ERPF)/(1.0 – Hematocrit)

ERPH = effective renal plasma flow, basically, renal plasma flow.
Equation: Filtration Fraction
Filtration Fraction = GFR/RPF
Equation: Filtered Load
Filtered Load = GFR x plasma concentration
Equation: Total Body Water (weight)
60% of body weight
Equation: Intercellular Fluid (weight)
40% of body weight
Equation: Extracellular Fluid (weight)
20% of body weight
Equation: Interstitial Fluid (weight)
15% of body weight (part of the 20% of the body weight made up of extracellular fluid)
Equation: Plasma (weight)
5% of body weight (part of the 20% of the body weight made up of extracellular fluid)
Major INTRACELLULAR cation
Potassium
Major EXTRACELLULAR cation
Sodium
Osmolality vs. Tonicity
Osmolarity: Amount of solute per given volume of water

Tonicity: Amount of solute per given volume of water that CANNOT cross the membrane
ADH secretion will respond faster to changes in ________ rather than _______.
osmolarity, volume

...more sensitive to osmolarity
T of F: Hyponatremia can occur in the setting of a normal/excess/deficient amount of total body sodium.
TRUE, it can simply be due to whatever amount of sodium you have being too diluted/concentrated/etc...
T or F: Hyponatremia can cause symptoms.
TRUE, for example, once you get down towards 110mEq/L, then you could have seizures and slip into a coma.
What is the important gauge you use to treat a hyponatremic patient - the sodium level itself (the measured value) or symptoms?
SYMPTOMS - correct a normal-appearing patient's hyponatremia SLOWLY, and correct a seizing/symptomatic patient's RAPIDLY. (The rate sodium correction is proportional to the rate of Sx onset.)
What is the irreversible brain injury caused by too rapid correction of hyponatremia?
Central Pontine Myelinolysis
As far as Effective Arterial Blood Volume is concerned (EABV), the biggest deal about cirrosis _________ of the splanchnic vasculature.
Vasodilation
Define and Equation: Fractional excretion of sodium
The percentage of sodium actually excreted after being filtered out in the glomerulus:
(Urine [Na] / Plasma [Na]) / ((Urine [Creatinine]) / (Plasma [Creatinine])) * 100
Fractional excretion of Na GREATER than 1% means you're in a sodium _____ state.
losing
Fractional excretion of Na LESS than 1% means you're in a sodium _____ state.
retaining
Treatment of edema (three steps in appropriate order)
1 - Treat underlying disease
2 - Decrease sodium and water intake
3 - Increase excretion of Na and water (Diuretics, local compession (stockings), and bed rest)